title: Defining predictors for long progression-free survival after radioembolisation of hepatic metastases of neuroendocrine origin.
abstract: OBJECTIVE
  To define predictive parameters of long progression-free survival (PFS) in patients undergoing radioembolisation of neuroendocrine liver metastases.
  
  
  METHODS
  The following clinical and magnetic resonance imaging (MRI) parameters of 45 radioembolised patients (median age, 62 years; range, 43-75) were reviewed: age, gender, levels of chromogranin A and neuron-specific enolase (NSE), primary tumour site, Ki-67 proliferation index, hepatic tumour load, number of metastases, signal intensity characteristics, vascularisation, haemorrhagic and necrotic transformation and fluid-fluid levels. PFS was assessed according to RECIST 1.0. Statistical analysis included univariate Cox regression, Kaplan-Meier and multivariate regression.
  
  
  RESULTS
  Median PFS was 727 days (95 % CI, 378-964). In the univariate regression analysis, hypovascular metastases progressed earlier (111 vs 727 days; P < 0.05). A Ki-67 ≤2 % was associated with a longer PFS than a Ki-67 of 3-20 % or >20 % (911 vs 727 vs 210 days, respectively; P < 0.05). Low NSE predicted longer PFS (911 vs 378 days; P < 0.05). In the adjusted multivariate analysis, vascularisation (hypervascularisation vs. no hypervascularisation; P = 0.0009) and NSE level (low vs high; P = 0.0119) had the strongest influence on PFS.
  
  
  CONCLUSIONS
  Response to radioembolisation in patients with neuroendocrine liver metastases can be predicted by the metastatic vascularisation pattern, the NSE level and the Ki-67.
  
  
  CONCLUSIONS
  • Radioembolisation is an effective treatment in hepatic metastases of neuroendocrine origin. • Pre-therapeutic vascularisation patterns of metastases on MRI can predict long progression-free survival. • Assessment of pre-therapeutic markers provides better therapy planning.
authors.affiliation: Department of Clinical Radiology, University Hospitals-Grosshadern, Ludwig-Maximilians University, Munich, Germany, wieland.sommer@med.uni-muenchen.de.
authors.forename: Wieland H
authors.initials: WH
authors.lastname: Sommer
authors.forename: Felix
authors.initials: F
authors.lastname: Ceelen
authors.forename: Xabier
authors.initials: X
authors.lastname: García-Albéniz
authors.forename: Philipp M
authors.initials: PM
authors.lastname: Paprottka
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Auernhammer
authors.forename: Marco
authors.initials: M
authors.lastname: Armbruster
authors.forename: Konstantin
authors.initials: K
authors.lastname: Nikolaou
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Haug
authors.forename: Maximilian F
authors.initials: MF
authors.lastname: Reiser
authors.forename: Daniel
authors.initials: D
authors.lastname: Theisen
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D016461:Chemoembolization, Therapeutic / Q000379:methods; D059248:Chemoradiotherapy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000628:therapy*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000175:diagnosis / Q000556:secondary / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents